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Friday, April 13, 2012

India should harvest the advantage of healthy ageing - livemint.com

India’s demographic profile, with nearly half its population younger than 25 years, is seen as a huge asset for its economy. But the World Health Organization (WHO) has projected that India’s elderly may outnumber children under the age of five in the next five years. In an interview, Dr Nata Menabde, WHO’s representative in India, said there was an urgent need to break stereotypes related to ageing and create models that use the elderly as a “valuable human capital” instead of treating them as an economic burden. Edited excerpts:

This year 2012 on the World Health Day 7th April, WHO is emphasizing on “new models of aging”. What does that mean in the Indian context?

We, in WHO, are of the opinion that there is a need to re-invent ageing. This year’s theme aims to redefine the perception of ageing. Ageing does not have to be associated with immobility, humiliation, uselessness and dependency. Giving financial protection, regardless of the family’s status, has to become a societal responsibility. Elderly persons cannot be left alone on the goodwill of family. We are talking about a societal change in the mindset. India’s legislation has taken case of this by the Senior Citizen Act, which states that a family has to take care of their elderly. But all solutions will not come through law. There is a need for adequate design in universal health coverage, which gives financial guarantees. Senior citizens should have access to social care. The key message is that senior citizens can continue to provide active input in families, in their communities and even engage in labour market.

In addition to having a law in place, there is need to ensure that dignity of senior citizens is kept intact. No individual should be treated as a burden. We are talking about dignified aging without any humiliation. They do have a right to expect this from the society, not as an act of charity, but as an entitlement.

What are the implications of a rising elderly population for India?

We should not be scared of this; instead, we should harvest advantage of healthy ageing. The growth of aging population in India is fast. Currently, we have 7.4% and this will go up to 12% by 2025, and by 2050, every fifth Indian will be in this age bracket.

In the next five years, India will have more senior citizens than children under the age of five. Additionally, the family size is reducing with less number of children being born. We need to think on the lines of keeping our elderly population productive in the community. This will help release the younger workforce from certain responsibilities like taking care of children, etc.

Speaking in absolute number, we will reach 300 million, but we have to stop looking at this as burden on the society. Right now is the time to build a mechanism, ensuring that senior citizens do not become a burden later on.

The elderly and the economically weaker sections face the same problems with our public health system. Is the issue, then, of governance and healthcare delivery?

Indeed. Many problems in the health sector are systemic and they affect all citizens, in all age groups. The healthcare reforms currently being discussed by the government will hopefully bring improvement in the systemic design, which will benefit all age groups, including the elderly.

Having said so, I must add that historically in India, there is a tendency to perform better when specific interventions are designed for particular target groups. Those interventions are also needed to make problems facing the elderly a priority in governance. Adequate investments need to be made by the government in healthcare for the elderly. These, of course, will only give returns if health sector reforms are done to improve infrastructure, manpower, etc.

Are there any differences in the issues concerning the elderly in developed and developing countries?

Different countries have tried different mechanisms and developed nations are obviously ahead of the curve in this regard because they have been hit by the ageing population a little earlier than say India. The same issues presented themselves two decades earlier in the West. Age is catching up with India faster than realized. In my opinion, these models need to be studied in terms of applicability since all of those won’t be useful in India’s context. The rural population and gender issues are not common in other countries. Models that work in other countries have to be adjusted to India’s reality and implemented.

The government is planning to reform the healthcare sector. In your interaction with the health ministry, do you see the political will required to bring about a change?

Political will is important to make any headway, especially if the project involves changing set behavioural patterns. A good government addresses the gaps in the system to bring in the poor, aged and vulnerable in the fold of development. New initiatives or laws will not be successful if there is no political ownership. The tobacco campaign is a good example. In terms of political will, several initiatives have proven that the government is willing to alleviate problems raised by us. However, what we are saying is that looking solely at elderly care will not work without comprehensive reforms that bring the ageing population in the fold of active social life.

Is blaming everything on the increase in “nuclear families” fair?

Of course not. There is a rural-urban dimension to this problem. Almost 75% of India’s senior citizens live in rural areas. There is a need for special attention in this area. India needs to invest in institutional mechanisms such as day care centres, old-age homes, etc., which are currently concentrated in cities. We don’t know all the implications of a demographic shift in the society as yet. More understanding has to be gained in this from the latest census figures.

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